Augmentative and alternative communication with children with severe/profound intellectual and multiple disabilities: speech language pathologists' clinical practices and reasoning

PURPOSE

Augmentative and alternative communication (AAC) is recommended to be included in communication interventions directed at children/youth with severe/profound intellectual and multiple disabilities (S/PIMD). Even so, the evidence base for AAC practices with children with S/PIMD is limited. Also, little is known about how frequently AAC is implemented with this target group, which AAC tools and methods are applied, and the related clinical reasoning of speech-language pathologists (SLPs). This study aimed to explore SLPs' beliefs, clinical reasoning and practices in relation to AAC implementation with children/youth with S/PIMD.

MATERIALS AND METHODS

In this sequential, mixed-methods study, 90 SLPs working with children with disabilities within habilitation services in Sweden participated in an online survey. The survey answers were statistically analysed. Subsequently, focus group data were collected from seven SLPs and analysed using thematic analysis.

RESULTS AND CONCLUSIONS

Despite AAC being highly prioritized, SLPs found it challenging and complex to implement with this target group. A wide variety of AAC methods and tools were considered and implemented. Clinical decision-making was a balancing act between competing considerations and was mainly guided by the SLPs' individual, clinical experiences. The resources, engagement and wishes of the social network surrounding the child were considered crucial for clinical decision-making on AAC. Implications for research and practice are discussed.Implications for rehabilitationSpeech-language pathologists (SLPs) seemingly find a wide variety of Augmentative and Alternative Communication (AAC), ranging from unaided methods to assistive technology of various complexity, to be potentially suitable for children/youth with severe/profound intellectual and multiple disabilities (S/PIMD).The motivation and preferences of the social network surrounding the child with S/PIMD seem to influence SLPs' clinical decision-making on AAC to a high degree. Sometimes this may be considered an even more important factor than the abilities of the child.SLPs' clinical decision-making on AAC for children/youth is guided by their individual, clinical experience to a high degree.An increase in family oriented AAC intervention research targeting individuals with S/PIMD could potentially strengthen the association between research and the current, experience-based clinical practice.

Using concept mapping to guide dysphagia service enhancements in Singapore: Recommendations from the speech-language pathology workforce

PURPOSE

Optimising dysphagia service delivery is crucial to minimise personal and service impacts associated with dysphagia. However, limited data exist on how to achieve this in Singapore. This study aimed to develop prioritised enhancements that the speech-language pathology workforce perceived as needed to improve dysphagia services in Singapore.

METHOD

Using a concept mapping approach, 19 speech-language pathologists (SLPs) and 10 managers listed suggestions for dysphagia service optimisation. Within their groups, the collated suggestions were sorted based on similarity, and individually rated on a 5-point scale based on importance and changeability. Using cluster and bivariate analysis, clusters of similar suggestions and prioritised suggestions for service optimisation were identified.

RESULT

The SLPs and managers proposed 73 and 51 unique suggestions respectively. Six clusters were identified for each group, with similar themes suggesting agreement of service improvements. All clusters were rated as more important than changeable. The managers perceived services as easier to change. The SLPs and managers rated 37% (27/73) and 43% (22/51) of suggestions, respectively, as high priority, with similarities relating to workforce capacity and capability, support and services access, care transitions, and telehealth services.

CONCLUSION

Prioritised enhancements identified by SLPs and managers provide direction for dysphagia service optimisation in Singapore.

Speech-language pathologists' perceptions of childhood bilingualism

The value of learning multiple languages has increased in the past 20 years. Despite this, some professionals continue to provide misinformation about bilingualism to many families around the United States, resulting in recommendations of implementing a monolingual approach for children. This study investigated the perceptions held by speech-language pathologists (SLPs) regarding childhood bilingualism. A total of 320 SLPs completed a survey stating their perceptions on childhood bilingualism for typically developing children and children with disabilities. Based on the number of responses, 292 participants were analysed quantitatively utilising a binary logistic regression to identify whether SLPs thought childhood bilingualism was advantageous or neutral, while incorporating the predictors of bilingual status and bilingualism education received. Additionally, a qualitative content analysis was conducted on 173 participants' responses to an open-ended question about their perceptions on childhood bilingualism. Results revealed that SLPs' bilingual status did not predict the probability of an advantageous perception for typically developing children, but it did for children with disabilities; however, SLPs who had received bilingualism education had a higher probability of having advantageous perceptions in both populations. Qualitative results revealed the use of appraisals related to multiple themes. This study served to understand the thoughts of SLPs in relation to the education they are providing to parents and the services they are providing to different populations - whether it be typically developing children or children with disabilities. There are implications for bilingual and cultural-linguistic education to be implemented across graduate programmes to ensure that optimal services are provided to the diverse groups in our case loads.

Tube feeding in advanced dementia: Insights from South African speech-language therapists

BACKGROUND

 Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs' perceived practices is warranted.

OBJECTIVES

 To qualitatively describe a sample of South African SLTs' perceived practices regarding feeding tube placement in people with advanced dementia.

METHOD

 Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis.

RESULTS

 Three main themes were identified: (1) factors influencing SLTs' decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs' decision-making and (3) SLTs' considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants' decisions about tube feeding.

CONCLUSION

 Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs' overall practices and ethical service delivery for people with advanced dementia and their families.Contribution: Factors and needs regarding SLTs' decision-making about feeding tubes in people with advanced dementia are highlighted.

Assessment of dementia knowledge in Indian speech-language pathology students

OBJECTIVES

Speech-language pathologists (SLPs) have a crucial role in assisting individuals with dementia due to the communication and swallowing challenges associated with the disease. As the number of dementia cases rises in India at an increasing rate, investigating the level of dementia knowledge of SLP students can offer insight into the preparedness of the healthcare system to meet this emerging demand.

METHOD

A cross-sectional survey was conducted on SLP students pursuing their final year undergraduate, postgraduate and doctoral degrees from four universities across India. Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale (DKAS) and information about previous dementia exposure (both formal and informal) was collected. The collected data were analysed using quantitative methods.

RESULTS

A total of 220 students (64.70% response rate) completed the survey. Overall dementia knowledge was inadequate with an average score of 22.08 ± 10.06. Previous dementia exposure among the students was also found to be low and did not affect dementia knowledge scores.

DISCUSSION

Despite the fundamental role SLPs play in the care of individuals with dementia, the lack of knowledge in this area emphasizes the need for enhancing dementia training programs through educational curricula and clinical placements.

Current practices of Portuguese speech-language pathologists with preschool-age children with pragmatic impairment: A cross-sectional survey

This study aims to investigate the practice patterns used by Portuguese speech-language pathologists (SLPs) with preschool-age children with pragmatic impairment and to identify the actual need(s) perceived by SLPs in this field. A total of 351 SLPs responded. The results reveal that 81.5 per cent of the respondents (n=286) reported working or had previously worked with preschool-age children with pragmatic impairment arising from autism spectrum disorder, developmental language disorder, or both. Considering the clinical practice, similarities and differences were found, many of which are due not to the inherent characteristics of each disorder but to the scarcity of research in clinical pragmatics. These results are also reflected in the needs perceived by SLPs and the degree of confidence with which they work with these children. Implications for clinical practice and directions for future research are discussed.

Speech-language pathologists' perceptions of augmentative and alternative communication in Thailand

Augmentative and alternative communication (AAC) systems are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs in Thailand, understanding speech-language pathologists' (SLPs) perceptions toward various AAC systems is an important first step. This study assessed SLPs' perceptions of three AAC modalities: gestural communication, communication boards, and iPad1-based speech-output technologies. A total of 78 SLPs watched three video vignettes of a child using each mode and rated their impressions of intelligibility, ease of learnability and use, effectiveness, and preference. Then they were asked to rate factors on visual analog scales that provided additional insights into their rationales and their preferences for AAC modalities for nonverbal clients and for themselves if they were nonverbal. The results indicated that most of the SLPs rated iPad-based speech-output technologies as being the more intelligible, effective, and preferred mode of communication. Gestural communication was rated as the easiest mode to learn and use for a child with complex communication needs. Despite infrequent use of iPad-based speech-output technologies in Thailand, SLPs' ratings indicated high social acceptance of this modality for promoting communication abilities of children with complex communication needs. Results also revealed some biases and lack of knowledge about AAC systems in Thailand.

Speech-Language Therapy Through Telepractice During COVID-19 and Its Way Forward: A Scoping Review

The overall burden of voice disorders is vast, and speech-language therapy has been in use for long to prevent, assess, diagnose, and treat different speech and language disorders. Due to the COVID-19 outbreak, these services are not readily accessible because of various precautionary measures that have been laid down by the government to check the blowout of infection; as a solution to this, there has been a rise in telepractice. The purpose of this review article is to study the usefulness of telepractice for speech-language therapy during the COVID-19 pandemic and its way forward. Search was performed in the PubMed database. A total of 102 articles were found, out of which 32 articles were included through a comprehensive inclusion and exclusion criteria. This study analyzes various papers on the use of telepractice during COVID-19 for speech-language therapy. The satisfaction was greater among women as compared to men because women could get the appointment done at home and they could easily manage their household chores. It has been recognized as an "attend anywhere" web-based platform that provides us with the 5 C's, namely, easy-to-access care, increased comfort, increased convenience, reduced cost, and higher confidentiality. Patients look for such sessions in the future, even when the pandemic is over. Telepractice has now been accepted as the new healthcare delivery model with multiple advantages and disadvantages. However, more research needs to be done on the moral and environmental aspects related to its use.

An exploratory study of speech-language pathologists' clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19

PURPOSE

To explore speech-language pathologists' (SLP) practice in literacy prior to, and during, COVID-19 to understand the practicalities, feasibility and sustainability of telepractice literacy services.

METHOD

This exploratory study employed a cross-sectional survey comprising 46 questions covering participants' caseload profile and service delivery models, their assessment and intervention practices and telepractice delivery of literacy services.

RESULT

Participants were 44 SLPs working primarily in private practice and education with children and adolescents. Students with literacy difficulties comprised a significant proportion of SLPs' caseloads. Individual and group sessions were the most common format of delivery prior to COVID-19. In a telepractice model during COVID-19, SLPs saw fewer students overall. Most provided individual sessions only and reported cancellation of group sessions. SLPs described their practice in literacy as being aligned with evidence-based principles. A range of resources were used for literacy assessment and intervention. For most, their usual practice changed for telepractice. Many felt underprepared to use telepractice and experienced numerous challenges mostly relating to technology and family engagement.

CONCLUSION

Literacy has become a core area of practice for SLPs; however, continued advocacy towards consultative and collaborative services is needed within onsite and telepractice models. Telepractice required SLPs to develop additional skills and modify usual practice. Despite experiencing challenges, many indicated they would continue with telepractice given its perceived benefits.

How acceptable is the use of linguistic-phonological intervention in children with cleft palate? A qualitative study in speech therapists

BACKGROUND & AIMS

Even though evidence for the use of linguistic-phonological intervention approaches in children with a cleft (lip and) palate (CP±L) is still limited, these approaches are being used by speech-language pathologists (SLPs) to treat active or compensatory cleft speech disorders in clinical practice. It is, however, unknown to what extent linguistic-phonological intervention is acceptable to SLPs. The aim of this study is to investigate the retrospective acceptability of linguistic-phonological intervention in children with a CP±L from the perspective of SLPs using the theoretical framework of acceptability (TFA).

METHODS & PROCEDURES

A total of 18 female community SLPs, aged between 23 and 63 years, were included in the study. An independent interviewer conducted semi-structured interviews. Data were analysed using a deductive coding approach. Statements of the SLPs were related to the seven constructs of the TFA: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy.

OUTCOMES & RESULTS

The affective attitude and perceived effectiveness of linguistic-phonological intervention differed among the SLPs: some therapists had positive attitudes towards these approaches, while others did not. Positive attitudes were related to the successful use of linguistic-phonological intervention in the past. The construct 'ethicality' revealed that negative attitudes towards these approaches were attributed to the limited available scientific evidence or negative experiences while using these approaches. In contrast, SLPs who had positive attitudes considered these interventions as 'important' and 'valuable'. Some SLPs had negative reflections on linguistic-phonological intervention as these approaches were considered demanding in terms of time needed to gain knowledge on using them in children with a CP±L (constructs 'burden' and 'opportunity costs'). Additionally, some SLPs doubted their self-efficacy to use these approaches in clinical practice.

CONCLUSIONS & IMPLICATIONS

The acceptability of linguistic-phonological intervention differed between the SLPs in this sample and was most likely related to their previous experiences with these linguistic-phonological approaches. It is important to increase not only the amount of scientific evidence for linguistic-phonological approaches but also the supply of evidence-based workshops and training courses on this topic. These initiatives should distribute scientific information that is translated into guidelines that are immediately applicable in clinical practice. This may potentially reduce the time-related burden that some SLPs currently experience to gain expertise in this matter. In future research, it is necessary to investigate if there exist differences in acceptability between the different types of linguistic-phonological therapy.

WHAT THIS PAPER ADDS

What is already known on this subject Linguistic-phonological speech intervention approaches are often used by SLPs to treat active or compensatory cleft speech disorders in clinical practice. What this paper adds to existing knowledge This study investigated whether linguistic-phonological intervention cleft speech intervention is acceptable to SLPs. Some therapists had positive attitudes towards these approaches, while others did not. Positive attitudes were related to the successful use of these approaches in the past. If SLPs indicated having negative attitudes, these negative feelings were attributed to the limited available scientific evidence or negative experiences while using these approaches. What are the potential or actual clinical implications of this work Even though linguistic-phonological speech intervention approaches are being used in clinical practice, these approaches are not always considered acceptable by SLPs. Acceptability could be enhanced by increasing the amount of scientific evidence for linguistic-phonological approaches, but also by increasing the supply of workshops and training courses on this topic. These initiatives should distribute hands-on information that is immediately applicable in clinical practice. This may potentially reduce the time-related burden that some SLPs currently experience to gain expertise in this matter.

Speech-language pathologists' perceived competence in serving people with Parkinson's in India: A cross-sectional survey study

BACKGROUND

Speech-language pathologists are often involved in the assessment and management of communication, cognition and swallowing deficits in people with Parkinson's. However, speech-language pathologists' self-perceived competency levels in serving people with Parkinson's remain elusive, especially in the Indian context where there is an increasing disability burden due to Parkinson's disease. Additionally, the challenges faced by speech-language pathologists in India to provide efficient services to this population are unidentified.

AIMS

To determine speech-language pathologists' self-perceived competence and challenges faced when providing services to people with Parkinson's in India.

METHODS & PROCEDURES

A survey questionnaire was sent to speech-language pathologists through emails and social media asking them questions to evaluate self-perceived competency in serving people with Parkinson's and to identify the challenges to their service delivery. A total of 69 speech-language pathologists responded to the survey.

OUTCOMES & RESULTS

The majority of respondents reported to be competent in dealing with various domains of assessment and management of people with Parkinson's. Although competent, they reportedly faced a few challenges during their service delivery.

CONCLUSIONS & IMPLICATIONS

This study provides an insight into the speech-language pathologists' self-perceived competency in serving people with Parkinson's in India, and also identifies the challenges related to interprofessional service delivery. The findings of the study have educational and clinical implications.

WHAT THIS PAPER ADDS

The study delineates speech-language pathologists' self-perceived competency in working with people with Parkinson's in India, a nation that is seeing a constant rise in the incidence of Parkinson's disease. The study the unique challenges within India to speech-language pathologists' service delivery for people with Parkinson's, thus having educational and clinical implications in Parkinson's disease care.

Malaysian speech-language pathology students' reflections about their participation in an AAC training program

Most speech-language pathologists (SLPs) in Malaysia practice with an undergraduate degree, which provides them with limited knowledge about and training in augmentative and alternative communication (AAC). This limited knowledge and training may affect their confidence and competence when introducing and using AAC with individuals for whom it is required. This study aimed to obtain feedback, via semi-structured interviews, from a group of 11 Malaysian university students who participated in an AAC training program about their experiences participating in and the effectiveness of the training program. Three themes were derived from qualitative content analysis of the interviews: (a)Time Demands, (b) Generalizing the use of AAC, and (c) Learning Required When Introducing AAC. The participants reported that they obtained better insights into the role of SLPs and communication partners with regards to AAC, as well as the struggles they faced. Students also reported increased confidence when working with individuals who use AAC after participating in the training program, thus supporting the need for similar training programs in the future.

Talking points: Oral histories of Australian and British speech-language pathologists who qualified in the three decades after 1945

Purpose: There has been limited academic exploration of the history of speech-language pathology (SLP). This article uses oral histories to explore the experiences reported by speech-language pathologists who began to practise in Australia and Britain, two politically related, but geographically very distant and distinct countries, in the first three decades after the Second World War.Method: Archived oral history transcripts from eight Australian and sixteen British speech-language pathologists were analysed using thematic network analysis (TNA).Result: Two global themes are reported, "personal stories" and "professional stories". Transcripts revealed the ways in which participants negotiated the social and cultural expectations of their time and place and how they developed professional identity and autonomy as their careers progressed. While there were many commonalities, there were both between- and within-group differences in the ways the two cohorts reported the details of their career progression.Conclusion: This article offers a picture of the challenges and experiences of Australian and British speech-language pathologists in the second half of the twentieth century. It highlights some of the changes over time and forms the basis for comparison with current working practices in the two countries.

Gauging Stakeholder Perspectives on Artificial Intelligence in Gender-Affirming Voice Care

BACKGROUND

As the main objective outcome measure used in gender-affirming voice care (GAVC), fundamental frequency (f₀ ) often fails to accurately reflect patient perceptions of their voice. Our team developed an artificial intelligence (AI) program that provides an alternative objective outcome measure that has the potential to more accurately align with patient perceptions.

OBJECTIVE

To gauge stakeholder receptivity to the use of AI in GAVC before employing a novel outcome measure in transgender and nonbinary communities.

METHODS

This prospective qualitative study used online focus groups composed of speech-language pathologists (SLPs), transgender men (TGM), transgender women (TGW), and nonbinary (NB) individuals. Participant age, race, gender, and geographic location were recorded. Each cohort participated in a series of two focus group sessions. The first session focused on participant experiences in GAVC, whereas the second ascertained participant perspectives on the use of AI in GAVC. Transcripts of each discussion were coded using Nvivo to perform inductive thematic analysis.

RESULTS

Seven SLPs, seven TGW, three TGM, and two NB individuals (mean [range] age, 35.5 [26-48] years) participated. Transgender and nonbinary participants were generally amenable to the technology, whereas SLPs were more hesitant about its use. Positive findings included appreciation for AI as an objective outcome measure and enthusiasm for its potential to longitudinally track progress. Hesitations concerned the actionability of using the AI and unease about the black box nature of the AI's analysis.

CONCLUSION

Transgender and NB individuals were receptive to the use of AI technology in GAVC, whereas SLPs were more apprehensive about using AI.

LEVEL OF EVIDENCE

NA Laryngoscope, 2022.

Implementation of the VA Intensive Dysphagia Treatment Program: A Mixed-Methods Evaluation

The Department of Veterans Affairs (VA) Intensive Dysphagia Treatment program serves a critical role in facilitating improvements to quality of care, standardization of outcomes, and increased access to structured therapy for Veterans with dysphagia. It has been implemented at 26 sites nationally and continues expanding. An explanatory sequential mixed-methods design was utilized for program evaluation to identify barriers and facilitators to implementation as reported by speech-language pathologists (SLPs) participating in the program. All 23 IDT program SLPs were invited to participate in an online survey. SLPs were asked to describe etiologies referred for SLP evaluation, most and least clinically useful program aspects, and characteristics of patients recommended for therapy. Qualitative interviews/focus groups were then conducted with 9 SLPs at 3 facilities with varying levels of program experience. Transcripts underwent systems engineering framework informed deductive thematic analysis. Interview/focus groups revealed overall positive feedback. Barriers included data entry challenges and provider understanding of long-term program goals, while facilitators included program structure enabling increased patient follow-up, outcomes tracking, and training in new treatment modalities. Through this evaluation process, program leadership garnered actionable feedback to improve further implementation of the IDT program. Ongoing efforts will further improve data entry, site onboarding procedures, and program communication.

Current practices of Malaysian speech-language pathologists working with dysarthria

Purpose: This study investigated the practice patterns used by Malaysian speech-language pathologists (SLPs) with patients with dysarthria, identified challenges perceived by SLPs and explored strategies to address perceived barriers for improving dysarthria management.Method: Two studies were conducted. Study 1 disseminated a 30-item survey questionnaire electronically via google link to SLPs in the Malaysian Speech-Language-Hearing Association through e-mail lists. Responses were analysed using descriptive statistics. In Study 2, semi-structured interviews of twelve SLPs who managed patients with dysarthria were conducted. Data were transcribed verbatim and analysed using the thematic analysis method.Result: Three major themes and ten sub-themes emerged from the interviews, including "assessment and treatment practices", "challenges", and "overcoming challenges". SLPs' practice of assessment and treatment of dysarthria were predominantly impairment-based. Respondents (64%) who never used standardised assessment tools valued textbooks more as sources of evidence and had a lower level of confidence in their knowledge about dysarthria compared to those who used standardised tools.Conclusion: Focus now needs to be on the education needs of our SLPs, on both the university training and continuing education levels, for direction of the development of professional training courses. Ongoing research and public awareness are required to guide clinical management decisions.

From excitement to self-doubt and insecurity: Speech-language pathologists' perceptions and experiences when treating children with a cleft palate

BACKGROUND

Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. Speech-language pathologists (SLPs) might have negative perceptions of the treatment of children with a CP±L.

AIMS

To explore how community SLPs perceive and experience the provision of speech intervention to children with a CP±L.

METHODS & PROCEDURES

A total of 18 female community SLPs, aged between 23 and 62 years, were included in this study. Semi-structured interviews were conducted. The interviews were analysed using an inductive thematic approach aiming to identify themes driven by the data. Trustworthiness of the data was achieved by including researcher triangulation (involving three researchers with different research backgrounds) and deviant case analysis of two cases.

OUTCOMES & RESULTS

Initial responses demonstrated that the community SLPs were excited and enthusiastic to treat children with a CP±L. Expanding on these initial reports, however, they revealed that their excitement turned into professional self-doubt and insecurity when confronted with the treatment challenges inherent with this population. To cope with this self-doubt, they outlined several responsibilities for the cleft team SLPs. They expressed a strong desire to receive confirmation and approval on their treatment practices from more experienced SLPs (i.e., the cleft team SLPs). Their perceptions were dominated by a polarized thinking pattern. Treatment approaches were divided in categories as 'right' or 'wrong' and 'good' or 'bad'.

CONCLUSIONS & IMPLICATIONS

The community SLPs are lacking professional confidence when treating children with a CP±L. They put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready-made answers to problems and questions. This expectation can perhaps be explained by their fear of making mistakes during therapy preventing treatment progress. If they handle in accordance with the experts' advice, they cannot blame themselves in cases where no treatment progress is seen. Educational programmes need to pay more attention to gaining professional confidence (in the search for the most optimal treatment approach for each individual patient) rather than merely focusing on competency-based learning tools.

WHAT THIS PAPER ADDS

What is already known on the subject Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. What this paper adds to existing knowledge This study explored how community SLPs' perceive and experience the provision of speech intervention to children with a CP±L. The perceptions of community SLPs are dominated by a polarized thinking pattern. Treatment approaches are divided into categories as "right" or "wrong" and "good" or "bad". They lack professional confidence when they treat children with a CP±L. The community SLPs put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready-made answers to problems and questions. What are the potential or actual clinical implications of this work? Educational programs in speech-language pathology need to pay more attention to gaining professional confidence rather than merely focusing on competency-based learning tools.

Meeting the communication needs of students on the autism spectrum in Australian classrooms: Adjustments reported by educators and specialists

PURPOSE

The purpose of this study was to examine educators' and specialists' provision of communication adjustments for students on the autism spectrum in mainstream and supported education settings.

METHOD

Secondary analysis of data collected from educators and specialists in the Australian Autism Educational Needs Analysis was undertaken. Thematic analysis of adjustment descriptions identified 11 categories. The use of the 11 specific adjustment categories with reference to (a) participant group (educator versus specialists), and (b) setting (mainstream versus supported) were described and associations investigated using Chi-square analyses.

RESULT

Only 32% of the 381 educators and specialists reported using adjustments. Of the adjustments reported, those categorised as "Multimodal Communication", "Structured Teaching", and "Assistive Technology" were frequently included by both groups. Significant associations were apparent between groups and the use of specific adjustments including naturalistic communication strategies. Significant differences were evident in the proportion of specific adjustments used by participants in supported as opposed to mainstream settings.

CONCLUSION

Possible reasons for the differences in the adjustments reported by educators and specialists and the role that setting may play in these are discussed. These include resourcing, the choice of adjustment being driven by school setting rather than student need, and possible differences between professionals in describing the adjustments made.

Impact of coronavirus disease 2019 on professional practices of audiologists and speech-language pathologists in India: A knowledge, attitude and practices survey

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread throughout the world and become a global pandemic. This has hampered and led to drastic changes in the functioning of healthcare services, forcing the professionals to adapt and work efficiently. The present study aimed to explore the impact of COVID-19 on the professional practices of audiologists and speech-language pathologists in India using a cross-sectional knowledge, attitude and practices survey.

MATERIAL AND METHODS

The study was conducted in two phases; phase one involved development and validation of the questionnaire, while phase II involved data collection. A cross-sectional self-reported internet-based study using convenience sampling was carried out.

RESULTS

Two hundred and eleven audiologists and speech-language pathologists responded to the survey. Overall, the professionals exhibited good knowledge levels regarding the COVID-19 outbreak. However, there were differences in their attitudes towards service delivery in the midst of the pandemic. Further, poor practices towards infection control measures especially in terms of hand washing was noted.

CONCLUSION

The findings of the present study are useful in highlighting the need to create better awareness among these professionals about appropriate and standard infection control measures. There is a need to have in place standard operating protocols for hand wash and infection control as well as inclusion in curriculum.

Dementia knowledge, attitudes and training needs of speech-language pathology students and practitioners: A countrywide study

BACKGROUND

Due to dementia-related communication difficulties, speech-language pathologists (SLPs) play a significant role in supporting individuals with dementia and their caregivers. Nevertheless, SLP practitioners may not have received adequate dementia training during their undergraduate programme and skills updating post-qualification. Investigating the knowledge, attitudes and training needs of SLP students and practitioners would provide evidence on the need of enhancing training in dementia care and management at both the undergraduate level and through continuous professional development programmes.

AIMS

To assess the levels of dementia knowledge, attitudes and training needs of SLP students and practitioners.

METHODS & PROCEDURES

A countrywide survey was conducted with undergraduate students reading for a BSc degree in communication therapy and SLPs currently in practice. Dementia knowledge and attitudes were assessed using the Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitude Scale (DAS). Training needs were measured using a three-point Likert scale from a list of topics related to dementia management and care. Quantitative methods were used to analyse the collected data.

OUTCOMES & RESULTS

A total of 49 SLP students (94.2% response rate) and 113 practitioners (57.4% response rate) completed the survey. Although SLP practitioners scored significantly better than students on the ADKS and its constructs, both cohorts showed inadequate knowledge of dementia, in particular dementia risk factors. In general, both SLP students and practitioners showed positive attitudes towards individuals with dementia, even though significant differences were observed. With respect to training needs, SLP practitioners significantly scored less compared with students denoting that, in this cohort, there was the belief that less training in dementia was required.

CONCLUSIONS & IMPLICATIONS

Although SLPs have an important role to play in the management and care of individuals with dementia, the findings of this study indicated a shortage of in-depth knowledge in this area of practice. This continues to highlight the need of enhancing dementia training programmes through undergraduate curriculum development and continuous professional programmes for skills updating. What this paper adds What is already known on the subject One of the symptoms of dementia is that affected individuals progressively lose the ability to communicate effectively. With an increase in the number of people with dementia due to global ageing growth, SLPs are more likely to come into contact with such individuals and their caregivers. At present, there is little research on the levels of dementia knowledge, attitudes and training needs among individuals pursuing their career in this profession. What this paper adds to existing knowledge This study highlights a dearth of in-depth knowledge among undergraduate students and practising SLPs in various aspects of dementia management and care and argues on the need of enhancing training in this field of study. What are the potential or actual clinical implications of this work? Improving SLPs' knowledge on dementia can enhance their professional role in several areas, including the provision of information on risk factors, disease progression and its effect on communication abilities, screening of cognitive communication difficulties and developing management plans aimed at maintaining communication abilities at the highest level.

A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study

INTRODUCTION

Rehabilitation post-stroke is critical for maximizing patient outcomes. This study assessed the feasibility of implementing and evaluating a continuing professional development (CPD) intervention aimed at increasing the uptake of stroke best practice guidelines among physiotherapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) in six university-affiliated stroke rehabilitation centers in Quebec, Canada.

METHOD

Twelve stroke best practice recommendations with reflective tools were sent weekly by e-mail. Participants' eligibility criteria included: a) profession; b) practicing more than 1 year in a stroke rehabilitation program; c) fluency in French or English; and d) basic computer literacy. Feasibility (operationalized via participation, satisfaction and relevance), cognitive impact, perceived application in practice and expected patient outcomes were measured over 24 weeks using three questionnaires and analyzed using descriptive statistics.

RESULTS

The sample totaled 62 of 133 eligible (47%) clinicians. Satisfaction, relevance and cognitive impact of delivered information varied across disciplines and recommendations. Agreement with the recommendations was high across disciplines. On average, three-interdisciplinary recommendations (related to post-stoke depression, post-stoke fatigue and patients' and caregivers' learning needs) were rated as the most relevant for at least one patient. The majority of clinicians would use the recommendations for a specific patient and expected health benefits by applying those recommendations.

CONCLUSION

This study demonstrated the feasibility of assessing the impact of a CPD intervention in stroke rehabilitation uptake and informed the design of a research program aimed at increasing the use of stroke evidence-based rehabilitation interventions.

Knowledge and attitudes toward transgender community among speech-language pathologists in India: A questionnaire-based exploration

Background: During the transition process, transgender individuals may require voice and communication services. Speech-language pathologists are increasingly involved in rendering clinical services and assisting transgender clients in voice and communication therapy. Previous studies in different countries have highlighted the lack of competence expressed by the speech-language pathologists toward serving the members of the lesbian, gay, bisexual, transgender, and queer communities. Presently, no such findings are available in the Indian context. Thus, a need was felt for identifying the concerns toward treatment for transgender individuals in speech-language pathology settings in India. Aim: The aim of the present study was to assess the knowledge, comfort levels and attitudes of speech-language pathologists practicing in India regarding the transgender community. Method: An online survey method was used to assess the knowledge and attitudes among speech-language pathologists working in India toward the transgender community. Results: The findings of the study revealed higher comfort levels as compared to self-rated knowledge levels in addressing issues related to transgender healthcare. Evidence-based practices toward transgender healthcare emerged as the topic needing more information. The study also helped to identify several moral beliefs and practices for voice therapy for the transgender population. Conclusion: There is a strong need to educate the speech language pathologists toward transgender healthcare in order to promote better cultural competence. The findings of the present study help to identify the lacunae in knowledge as well as to highlight the need to have continuing education programs in this area.

Comparing the codes of ethics of the six signatory associations of the Mutual Recognition Agreement

PURPOSE

The Agreement for the Mutual Recognition of Professional Association Credentials (MRA) between six national associations provides a mutually negotiated expedited process for applying for certification in speech-language pathology by any of the signatory associations. Although the MRA recognizes common standards in academic and clinical practice and eases the process to have credentials recognized, an interesting concept is that SLPs who have membership in more than one association must adhere to the code of ethics in each association. Thus, as SLPs will need to abide by them the question then becomes, are the codes of ethics in the six national associations comparable?

METHOD

Using a content analysis procedure, the authors sought to identify similarities between the six codes of ethics.

RESULT

The results revealed similarities between the six codes in areas such as responsibility to clients, professional conduct and practitioner competence.

CONCLUSION

The findings should not to be interpreted to imply that one code of ethics was better or more comprehensive than another, as each code of ethics must be understood and interpreted in temporal, situational and local cultural contexts. Rather, the discussion includes a proposal to create a unified document.

Creating communicatively accessible healthcare environments: perceptions of speech-language pathologists

There is a growing body of research that indicates that a person with a communication disability communicates and participates more effectively given a communicatively accessible environment. If this research is to be translated into practice then one needs to determine who will take on the role of creating communicatively accessible environments. This research adopted a qualitative methodology to explore the perceptions of speech-language pathologists about working to create communicatively accessible healthcare settings. Fifteen speech-language pathologists in three focus groups participated in this research. The focus group discussions were transcribed and analysed thematically. Thematic analysis indicated that speech-language pathologists believe there are four main benefits in creating communicatively accessible healthcare environments. These are Benefits for all people: Access for all, Benefits for healthcare administrators, Benefits for those wanting to improve communication with patients, and Benefits to the capacity to provide communicatively accessible environments. However, they believe these benefits can only be achieved if; The communication resources are available, Skilled, knowledgeable and supportive healthcare providers are available; and Systems are in place to support a whole-of-hospital approach. This research supports the development of a new role to improve the communicative accessibility of healthcare settings.

The current practices of speech-language pathologists in providing information to clients with traumatic brain injury

The provision of information about cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) is important given the impact these communication impairments can have on the rehabilitation of people with TBI. This study describes the results of an online survey which investigated the current practices of 74 Australian speech-language pathologists (SLPs) working with adults with TBI. Thirty-seven SLPs outlined their practices in information provision. SLPs reported they provide information to adults with TBI about CCDs, the impact of CCDs on participation in life activities, and rehabilitation from CCDs. In addition, SLPs identified barriers and facilitators to information provision. Barriers identified included time, impairments resulting from TBI, and personal characteristics of the client. Facilitators included family functioning and support and the multidisciplinary team. Findings of this research indicate a need for some changes in the format and content of information that SLPs provide to adults with TBI, to ensure they can achieve fundamental levels of health literacy and better health outcomes.